[Nephrotic syndrome in diabetis: evolution and prognosis about 35 cases]

The objective of our study was to evaluate the prognostic factors in the nephritic diabetic syndrome and its evolution. We realized a retrospective study of 35 cases of diabetic patients hospitalized between 1985 and 1999 who presented with a nephrotic syndrome. They included 17 females and 18 males, their mean age was 43 years [extremes: 18-77 years] and the mean duration of their diabetes was 10 years [extreme: 0-25 years]. The diabetes was insulin-dependent [type1] in 19 cases and non insulin-dependent [type 2] in 16 cases. Retinopathy and neuropathy were presents in 88% and 83% of the cases respectively. Nephrotic syndrome was secondary to a diabetic nephropathy in 26 cases [74%] and to a non-diabetic nephropathy in 9 cases [26%]. The mean follow-up was 4 years for 22 patients. Evolution was marked by a rapid decline of the renal function in 14 cases [63.6%]. Factors of bad prognosis seem to be the following: male sex [11 cases out of 14; 78,5%], type 1 diabetes [10 cases out of 14; 71,4%], poorly controlled hypertension [10 cases on 12; 83,3%], smoking [5 cases out of 14; 35,7%], hyperlipidemia [11 cases out of 14; 78,5%] and nephropathy caused by the diabetic condition [11 cases out of 14; 78,5%]. Control of these risk factors is thus important to prevent the progression of nephrotic syndrome

[Peripheral hypothyroidism and Cushing disease]

The presence of thyroid disorders in Gushing's syndrome is very common. These abnormalities demonstrate the effect of the cortisol on the different levels of hypothalamo-hypophyso-thyroid axis'. However, the association between primary hypothyroidism and Cushing s' syndrome is more rare. We report the case of a 55 year-old woman with a Gushing's disease because of pituitary macroadenoma. A primal]] hypothyroidism was diagnosed 8 years before in this patient because of obvious clinical features and was confirmed by decreased thyroid hormones levels and moderate TSH increase. Hypercortisolism induces a decrease in thyroid hormones, and changes in TSH wih less reactivity to TRH Suppression of hypercortisolism is associated with a normalisation of these functionnal thyroid disorders but also leads to an increase in autoimmune thyroiditis

[Congenital growth hormone deficiency: etiologic presentation of 13 cases]

Frequency of the congenital growth hormone [CH] deficiency is estimated to /4000 - 1/10.000 births. Its pathogenesis is multiple. We report 13 cases of congenital GH deficiency. Three cases [3 boys] are secondary to stalk interruption and GH deficiency is associated to ACTH deficiency in 2 cases and to gonadotropin deficiency in 2 cases but no patient has diabetes insipidus. shows a pituitary stalk interruption, an anterior pituitary hypoplasia and posterior pituitary ectopia. The causes of stalk interruption remain not clear. For the 10 other patients with congenital GH deficiency, genetic origin is suggested because of the clinical and biological presentation and by the normal MRI. GH deficiency is isolated in 5 cases in 10. We review the main mutations involved in GH deficiency [Prop-1, Pit-1, Lhx3 and Lhx4 genes]